Provider Demographics
NPI:1396224887
Name:BAINS, AMRIT (CCC SLP)
Entity Type:Individual
Prefix:MR
First Name:AMRIT
Middle Name:
Last Name:BAINS
Suffix:
Gender:M
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 ABALONE PL
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-8606
Mailing Address - Country:US
Mailing Address - Phone:925-518-3318
Mailing Address - Fax:
Practice Address - Street 1:21966 DOLORES ST
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-6900
Practice Address - Country:US
Practice Address - Phone:510-733-2419
Practice Address - Fax:510-583-1263
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21533235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1043489016Medicaid